Prioritizing health: The EPA must seize the opportunity to make our air cleaner

As the new year brings a renewed focus on staying healthy, resolutions of exercise and eating better can be accompanied by a third goal: breathing in cleaner air. A recent study shows that higher levels of fine particulate matter, an air pollutant, increases the risk of eight different heart-related diseases. Thankfully, this health goal does not require a gym membership. 

Any day now, the U.S. Environmental Protection Agency is expected to announce updated air quality standards (NAAQS) to regulate this pollutant. While the EPA has been advised by the medical community to strengthen these standards to protect health, polluting industries are pushing back, saying the economic cost of clean air is “too high.” 

Air pollution was responsible for 6.7 million deaths globally in 2019.  Fine particulate matter increases the risk of several causes of death in the United States, including lung cancer, heart disease, and dementia, making it arguably one of our most dangerous public health threats. 

So what really is the cost of improving our air?

As physicians, we do our best to treat patients with medications and lifestyle interventions, but really, it's hopeless unless we clean up the air and the environment in which our patients live. 

Fine particulate matter, also known as soot or PM_2.5, causes inflammation inside the lungs, exacerbating the risk of asthma attacks and impairing lung development in children. Higher levels of exposure increases the risk of heart attacks, strokes and cognitive decline, as well as the risk of pregnancy complications.  

Everyone is impacted by breathing in polluted air, but it is children, older adults, and pregnant women who are most at risk. This is why I, and health care providers across the country, are asking the EPA to strengthen the current standards of particulate matter air pollution to align with the consensus of the scientific community in protecting the health of our most vulnerable populations.

The majority of the Clean Air Scientific Advisory Committee, an independent panel of expert science advisors to the EPA, recommends decreasing levels of fine particulate matter in the air from 12 µg/m³  to levels as low as 8 µg/m³ for the annual standard and from 35 µg/m³ to 25 µg/m³ for the 24-hour standard. The American Lung Association, the American Academy of Pediatrics, and the American Heart Association all support these guidelines.  

Adverse health outcomes are especially concerning for communities of color, who are disparately exposed to higher levels of fine particulate matter. A DC-based case study by Dr. Susan Anenberg, an air pollution expert and Director of the Climate Health Institute at George Washington University, showed that neighborhoods with the highest attributable health impacts from fine particulate matter exposure, including heart disease, asthma visits, lung cancer, and stroke, have a greater percentage of Black Americans.  

But the good news is that regulatory processes like the proposed updated air quality guidelines can help address these health concerns.  A New England Journal of Medicine study shows that strengthening fine particulate matter standards is most beneficial to the health of Black Americans and those of a lower socioeconomic status. Doctors need these strengthened rules to protect our vulnerable patients.  

The argument has been made that strengthening the standards will negatively impact economic output. Industries such as mining, oil and gas, and manufacturing may have to adapt their practices to accommodate the updated standards. But history tells a different story.  

Since the Clean Air Act was enacted, the health benefits have exceeded the costs of implementation by a factor of more than 30-to-1. In other words, by improving air quality and avoiding heart attacks, ER visits, and lost work days, we’ve saved money. The EPA’s own estimates show that the long term economic benefits of strengthening the air quality standards outweigh projected cost considerations. 

Prior regulatory success shows us that initiatives to clean the air are successful. Closure of a coal processing plant in Pennsylvania resulted in a subsequent reduction in emergency department visits for heart related issues. In California, fertility rates of the surrounding community increased when eight polluting coal and oil power plants were retired. 

The health benefits are why doctors like myself are pushing the EPA to follow through as soon as possible on it main mission: to protect human health and the environment. Clean air is a priority, not a privilege. While there is no completely safe level of air pollution, one thing will make our year healthier-making our air cleaner by strengthening fine particulate matter standards.

Neelima Tummala is anENT surgeon and co-director of the Climate Health Institute at George Washington University.